About Dialysis Center Reports

The quality measures that are presented in your report are designed to
help you make meaningful comparisons between dialysis centers that you may
be considering for your treatments. "Quality" refers to how well a facility
cares for its patients. Good quality dialysis care means doing the right
thing at the right time and in the right way for the right person and getting
the best possible results!

We have provided three accepted quality measures for your comparison of
the dialysis centers you might be considering. The data we collect is gathered
from the U.S. government, is updated regularly, and is carefully reviewed and
displayed for your use. It is important that you recognize that these measures
are one thing to consider in your selection of a dialysis center and that there
are many other consideration you must consider. For example, you also might want
to make sure that the dialysis center accepts your insurance coverage, or that
the facility is close to your home.

Quality Measure #1

Hemodialysis Adequacy, or How Many Patients Receive Adequate Treatment at the Facility

The primary function of the kidneys is to filter waste from the
blood. One of the most abundant waste material is a chemical known as
"urea," a nitrogen containing substance found in the blood. The laboratory
test that measures this substance is know as a BUN (blood urea nitrogen)
test. BUN reflects the ratio between urea production and its clearance
through the kidneys. This test is useful in following the progress of
dialysis patients, and is normally performed before a patient has hemodialysis
and also after the procedure is completed. The calculations performed on
these two measurements are very important to the patient and is known as
the URR (urea reduction ratio) and reflects the success of the treatment.
The ratio is calculated in the following manner.

A URR of 65 or more means your dialysis treatment is adequate. You
should know what this number is and make sure you discuss it with your
doctor so you will have confidence that your treatment is adequate.

It also is important that dialysis centers make sure that the adequacy
of the treatments they perform on patients is appropriate. One of the
"quality measures" that you can look at to evaluate the performance of
a dialysis center is to look at the percentage of patients who had
enough waste removed from their blood based on the test results of the
patients that are served by the specific dialysis center. Several
factors can affect the percentage of a facility's patients who receive
adequate dialysis. A facility may be able to control some of these
factors, but not others. These factors can include:

how well it cares for its patients,

how healthy its patients are, and

whether its patients have good health habits.

Quality Measure #2

How Well a Facility Controls Anemia Rates among Patients

Many dialysis patients have anemia, a type of low blood count.
Anemia occurs when the amount of hemoglobin (the oxygen carrying
molecules in the blood) is lower than the established normal range
for humans (11 - 15 gm/dL). A simple test for this condition is
known as the hematocrit, which refers both to the packed cell
volume and to the percentage of the blood volume that is occupied
by red blood cells. Another measure for anemia is a test for hemoglobin
levels, and some facilities may measure this instead of the hematocrit.

When hematocrit is the measurement used, the lower limit of acceptability
for dialysis patients is 33%. This number is important to you and you should
know what this number is as many dialysis patients have anemia. You should
always discuss this measurement with your doctor. At the facility level,
the percentage of patients that have hematocrit levels higher than 33% is
considered a quality measure for dialysis centers and reflects how well a
center manages their patients with regard to anemia. As with the hemodialysis
adequacy, the hematocrit percentages can be affected by many things --
some of which the facility may be able to control, but not all of them.
These factors can include how well the center cares for its patients, but
also whether its patients have good health habits outside of the facility.
If you have questions about anemia, talk to your doctor or the staff at your
dialysis facility.

Quality Measure #3

Expected Survival Rate of the Hemodialysis Center

Another important piece of information you should know about a facility
is the "patient survival rate" for that facility. This rates is calculated
relative to the expected deaths for a four-year period and is considered a
measure of a facility's quality. There are a number of factors that are
attributed to the four-year expected survival rates, including age, sex, size,
race, ethnicity, whether or not the patients have diabetes, how long the
patient has had renal failure and if there was other health problems when
the patient started dialysis. The expected number of deaths is calculated
in the following manner:

(National death rate for patients on dialysis)×(the number of years that the patient was treated at the facility)(The "expected" number of deaths for patients on dialysis)

Expected deaths are calculated
for all patients in the facility to a total number of deaths expected for a
four-year period at the facility. Many factors can affect the actual patient
survival rates at a facility. A facility may be able to control some of these
factors, but not others.

Some factors that a facility may be able to control:

Taking good care of patients, like changing a patient's treatment when necessary, and ensuring the patient is on dialysis for the full treatment time.

Making sure that its patients get all the treatments prescribed by their doctors

Teaching patients to take good care of themselves.

Some factors that a facility may not be able to control:

Whether or not the patient already has other health conditions like heart problems or cancer.

Unexpected death of a patient. For instance, complications from surgery.

A patient not following the prescribed treatment. For instance, a patient refusing to finish a dialysis session or not taking medications as prescribed.

When patients first need dialysis, they may have moderate or severe
health issues that may or may not improve with adequate dialysis. For
this reason, facilities with more new patients may have a higher than
expected mortality rate.

If you have a question about a facility's rates, it's important that
you discuss it with your doctor or the staff at the dialysis facility.
You should contact the facility to find out its most recent patient
survival information.

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